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Surgery
For Hemorrhoids

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Two Common Surgical Techniques
Milligan-Morgan
Technique
This medical procedure was orinated in the
United Kingdom by both Dr. Milligan and Dr. Morgan back in
1937. It is the most common procedure done even now for
hemorhoids. This procedure excises the three major hemorrhoidal
blood vessels. Avoiding stenosis (a narrowing of the blood
vessel), there are three pear-shaped incisions which are left
open and separated by mucosae (thin layer of smooth muscle) and
bridges of skin. This is the surgery that is used as a standard
of which others are compared.
Ferguson
Technique
A physician by the name of Dr.
Ferguson modified the Milligan-Morgan Hemorrhoid surgery
technique in 1952. This procedure either totally or partially
closes incisions with absorbable sutures. A device called a
retractor is used to expose the hemorrhoidal tissue, which then
removed. The tissue that remains is sealed through coagulation.
It has been found that this technique does not bring real
advantages over the Milligan-Morgan technique because of the
commality of breakage of the sutures. Furthermore, there is no
difference in healing time or reduction in pain.
Stapled
Hemorrhoidopexy or PPH Procedure
PPH stands for Procedure for
Prolapse and Hemorrhoids. It is also referred to as
Stapled
Hemorrhoidectomy and Circumferential
Musosectomy. This surgical technique came a ways
from the Morgan-Milligan and the Ferguson techniques. It was
developed in the early 1990's and focuses on reducing the
prolapse of hemorrhoidal tissue. It excises a band of prolapsed
and mucosa membrane with a circular stapling device. The
prolapsed tissue is drawn into a surgical instrument which
enables excess tissue to be removed as the remaining
hemorrhoidal tissue gets stapled back into its correct
anatomical position.
The device used
is called a "Circular Anal Dialator" and is used to reduce the
prolapse anal skin and areas of the anal mucous membrane. After
the obstruction area is removed, the prolapsed membrane moves
into the Dilator Lumen (artery closure system). After this
takes place, another surgical instrument called the
Purse-String Suture Anoscope is inserted through the dilator.
This device pushes the prolapsed mucous back and up against the
rectal wall. The mucous membrane that comes through the
anascope can be held in a suture that only holds mucous
membrane. By rotating this device, it makes it possible to
suture the whole anal circumference in a "Purse-String"
suture.
The Hemorrhoidal
Circular Stapler is opened completely and inserted through the
dilator. It is then adjacent to the Purse-String Suture. Each
end of the suture is then exteranally tied closed.
Next, placing
slight pressure on the suture, the prolapsed membrane is pulled
into the circular stapling device. As the device is tightened,
the prolapse gets stapled. The device is held in place for half
of one minute and then fires off a staple. It does not release
immediately enabling homeostasis since the area is still held
in place.
The stapler
shoots off double staggered rows of titanium staples into the
tissue. A circular knife is then used to cut away any extra
tissue. It is a column of mucosa that is removed from the upper
anal canal. In the last stage, an anascope is used to review
the surgical procedure and to see if there is any bleeding
still taking place. If there is continual bleeding, further
absorbable sutures are anatomically inserted.

Circular Anal Dilator with
Purse-String Suture Anascope
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Rubber
Band Ligation
Elastic bands are
wrapped around the base of a hemorrhoid to cut off its blood
supply. Within several days, the hemorrhoid dies and falls off.
Some patients experience pain and bleeding after the treatment.
It does not cure the cause of hemorrhoids so they usually
reappear.
Infrared Coagulation
An Infrared beam is used to burn off some
tissues to cut off the blood supply to the hemorrhoid. Five to
six treatments (one per week) are necessary. Although it's
advertised as pain-free, many patients complain of intense pain
during treatment. It does not cure the cause so the hemorrhoids
usually reappear.
Hemorrhoidectomy
Hemorrhoidectomy is an
outpatient sugery that is done to remove hemorrhoids. It is
done using anesthesia or "spinal anesthesia" for the pain
associated with the surgery. Statistics have shown that this
treatment may cause incontinence later in life so it is
recommended only for severe cases. Many patients complain of
intense pain during recovery, so it should be the last resort.
The surgery is often done with scalpel, laser or cautery pencil
and there are two kinds of procedures used.
The first
procedure uses a circular stapeling device. It does not make
any incisions in the patient. The hemorrhoid is raised up and
the device simply staples underneath it.
Hemorrhoid Surgical
Stapler
The second
procedure is where there are incisions made around the
hemorrhoid and the hemorrhoid is then removed. At the same
time, the swollen vein is tied together to stop any bleeding.
The affected area is then stitched back together.

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When
Should You Have Surgery For
Hemorrhoids?
Doctors have come
up with a grading system in describing the depth or severity of
the hemorrhoid case. The severity is often in Stage three and
absolutly in Stage Four. It is labeled as follows:
First
Degree Hemorrhoids: Hemorrhoids that are bleeding but are
not prolapsing.
Second
Degree Hemorhoids: Hemorrhoids that have prolapsed but
actually retract by themselves with bleeding or without
bleeding.

Third
Degree Hemorrhoids: Hemorrhoids that have the ability to be
pushed back in by a finger.
 
Fourth
Degree Hemorrhoids: Hemorrhoids that can not be pushed back
in at all and are often "thrombosed." This means that it
contains blood clots and is a very serious condition. It can
also be a case of the rectal lining being pulled through the
anus.
It would be a
decision between you and the doctor of if you need to have the
surgery done and which kind is best for you.
Know your
options and question your doctor with knowledge so you have a
thorough understanding of the procedures and what to
do.


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